Cardiovascular Disorders

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Cardiovascular Disorders

• BCE 542 Physical Disabilities, Rehabilitation and
  Employment
• Dr. Dunn
• September 10, 2002

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The Heart

• A muscular organ that circulates blood through
  the body.
• Problems can result from
• Poor/restricted flow of blood in the heart.
• Inability of the heart to pump blood effectively
• Infections
• Problems with the hearts rhythm.

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Congenital Heart Defects

• Present at birth
• Acyatonic--do not interfere with the oxygenation
  of blood.
• Less severe, usually do not cause problems with
  functional capacities if corrected.
• Cyatonic defects--Involve problems with
  oxygenation of blood (tetralogy of fallot)
• Person likely to have problems with physical
  exertion even after surgical correction.

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Bacterial Infections

• Rheumatic Heart Disease
• Acute Develops after an infectious disease in
  children infection of heart muscle.
• Chronic A delayed effect of the acute disease
  involves scarring of heart valves. May need to
  be treated with valve replacement surgery.
• With valve replacement surgery, individuals may
  need to take blood thinners, which have to be
  closely monitored.
• Avoid risk of injury, due to thinned blood also,
  infections may develop into bacterial
  endocarditis.
• Person should avoid occupations in which there is
  high risk of physical injury.

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Bacterial Infections, cont.

• Bacterial or Fungal Endocarditis Infection of
  heart tissue (walls or heart valves).
• Particularly common among IV drug abusers.
• Serious complications include blindness due to
  damage to blood vessels of the eyes, aneurysms of
  the heart, can damage spleen and liver.
• Functional limitations vary according to
  resulting damage to heart function, other
  complications.
• Pericarditis--Similar disorder involving
  infection to the lining of the heart
  (pericardium).

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Ischemic Heart Disease (Coronary Artery Disease)

• Disorders involve blockage of the coronary artery
  (the blood vessel that feeds the heart).
• Angina Pectoris pain in the upper part of the
  body due to restricted blood flow in the coronary
  artery.
• Usually occurs after physical exertion or
  emotional upset.
• May be treated by coronary bypass, coronary
  angioplasty, nitroglycerin tablets, and
  sympathectomy.
• Person with angina must be protected from
  overexertion and emotional upset.

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Coronary Artery Disease, cont.

• Myocardial Infarction (Heart Attack)
• Complete blockage of coronary artery results in
  starvation and death of heart tissue (infarction)
• Resulting physical restrictions depend upon the
  size of the infarct (which is eventually replaced
  with scar tissue).
• Most people (3/4) return to previous employment
  after a heart attack
• The remaining 1/4 of heart attack patients must
  change to less stressful or physically demanding
  work.

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Congestive Heart Failure

• Inability of the heart to pump blood with
  necessary force.
• Blood pools in large blood vessels and major
  organs of the body fluid builds in lower
  extremities person is weak, short of breath.
• Treatment involves correction of the cause of the
  disorder.
• Functional restrictions can be minimal if
  corrected underlying cause of the disorder may
  carry additional restrictions.

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Cor Pulmanale

• Strain of the right side of the heart brought on
  by lung disease.
• Symptoms are similar to congestive heart failure,
  and congestive heart failure often develops as a
  result.
• Rehabilitation issues will usually involve
  underlying lung disease.
• Often may be a result of occupational lung
  diseases, such as black lung.
• This disorder may not develop until an individual
  is 50-70 years of age, at which time
  rehabilitation concerns may be moot.

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Cardiac Arrhythmias

• Problems with the rhythm of the heart beat.
• Most are not serious (tachycardia, bradycardia,
  sinus arrhythmia, premature contraction).
• Those that are serious (Heart block, atrial
  flutter, atrial fibrilation, ventral fibrilation)
  may be more serious and life threatening, often
  result from advanced heart disease, and have grim
  outlooks. Rehabilitation often is not feasible.
• May be treated with a pacemaker, digitalis
  medications.

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Vascular Diseases

• Disorders or dysfunctions involving the veins and
  arteries that carry blood through the body.
• Involve narrowing, blockage, or resistance to
  flow of blood.

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Hypertension (High Blood Pressure)

• Resistance to flow of blood in the blood vessels.
• Usually no known cause, no symptoms.
• Untreated can lead to serious medical problems.
• Treated with drugs, dietary restrictions.
• Usually is not a rehabilitation concern by
  itself--some persons with the disease in very
  high stress occupations may require occupational
  change.

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Arteriosclerosis/Atherosclerosis

• Blockage of the blood vessels, especially in
  abdomen and lower extremity, by fatty deposits.
• Symptoms include claudication (tightening of
  muscles, esp. in lower extremities),
  tingling/pain in lower extremities.
• Complete blockage of blood vessels can result in
  loss of blood flow to tissues, esp. in lower
  extremities, resulting in infarction of tissue
  and gangrene, making amputation necessary.
• Treated with diet and lifestyle restrictions,
  smoking cessation, bypass surgery to the veins.
• Functional Restrictions
• Restrictions in walking, standing, climbing.
• Avoid cold temperatures indoor, climate
  controlled environments are best.
• Skin trauma, esp. to lower extremities, should be
  avoided.

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Thromboanginis Obliterans (Buergers Disease)

• A constriction of blood vessels in the lower
  extremities usually occurring among men 20-40.
• Individuals with disease are almost always heavy
  smokers.
• Eventually leads to ulceration of legs/feet,
  infarction, gangrene, and amputation.
• Individuals who do not take necessary treatment
  steps will eventually lose both legs at or below
  the knee.
• Treatment involves smoking cessation, exercise,
  foot care.
• Rehabilitation considerations are similar as for
  arteriosclerosis, but this disorder can be of
  particular concern because of the age of those
  who usually acquire it.

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Varicose Veins

• Painful, inflamed veins near the surface of the
  skin of the legs.
• Very common, esp. among women over 40.
• Treatment involves elastic stockings, elevation
  of affected areas to allow blood drainage,
  surgical removal of affected blood vessels.
• Most people are able to continue working in usual
  position, but may need to avoid prolonged periods
  of standing in one place, as this causes pooling
  of blood in the legs and increased pain.

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Phlebitis/Thrombophlebitis

• Phlebitis is inflammation of a vein, usually in
  the leg.
• Thrombophlebitis is vein inflammation with
  formation of blood clots (embolisms)--which can
  break away and travel to heart, lungs or brain.
• Common in those who are immobilized, have serious
  illnesses.
• Post-phlebetic syndrome--a chronic complication
  involving swelling, pain, rupture of blood
  vessels, and unusual skin pigmentation.
• Treatment involves rest, elevation of legs,
  surgery, anticoagulant drugs. Post-phlebetic
  syndrome patients may wear pressure stockings.
• Rehabilitation considerations are most relevant
  in post-phlebetic syndrome, and are similar to
  those for varicose veins.

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Reynauds Phenomenon and Disease Livedo
Reticularis

• Reynauds Phenomenon and Disease
• Progressive discoloration of the skin, usually of
  the hands, from pale, to blue (cyatonic) to red.
• Usually caused as reaction to cold or emotional
  upset.
• Livedo Reticularis
• A similar disorder involving blueing of the skin
  in a fishnet like pattern.
• Disorders may be primary (with no known cause) or
  secondary (resulting from vascular disease) the
  secondary form of the disease may be life
  threatening can lead to finger ulcers, gangrene,
  and amputation.
• Rehabilitation concerns may not be necessary in
  the primary form of the disease. In the
  secondary form of the disease, it is important to
  understand the individuals prognosis and any
  underlying medical conditions. Damage to hands
  can affect dexterity and self-care.